Validación de un glucómetro en una unidad de cuidados intensivos / Validation of a glucose meter at an intensive care unit

Introducción Los pacientes ingresados en las unidades de cuidados intensivos (UCI) con hiperglucemia presentan mayor morbi-mortalidad que los pacientes normoglucémicos. Habitualmente, la monitorización de la glucemia de los pacientes en las unidades de cuidados intensivos es realizado por medio de glucómetros. El objetivo del estudio fue evaluar un glucómetro (StatStrip, Nova Biomedical) para determinar su grado de acuerdo con el método habitual de determinación de la glucemia en el laboratorio. Material y métodos Se recogieron 89 muestras de diferentes pacientes (76,4% hombres y 23,6% mujeres) ingresados en una UCI durante los meses de septiembre a diciembre del 2010. En cada extracción, se recogió un tubo de heparina litio y otro tubo de EDTA. La alícuota de sangre total era utilizada para la determinación de glucemia mediante el glucómetro. El tubo de heparina litio era procesado a la misma vez para la determinación de la glucemia plasmática (Analizador Cobas 6000, Roche Diagnostic, SA). Para evaluar el grado de acuerdo entre los dos métodos, seguimos el procedimiento indicado en la guía EP-9-A2 del Clinical and Laboratory Standards Institute (CLSI).Resultado La glucemia en sangre total medida por el glucómetro presentaba un valor medio de 126,53±49,28mg/dL con un rango de 33,5 a 431mg/dL y la glucemia plasmática del método de laboratorio reflejaba un valor medio de 138,13±78,6mg/dL con un rango de 43-451mg/dL. El coeficiente de correlación entre ambos métodos fue de 0,99 con un intervalo de confianza al 95% (IC) de 0,98 a 0,99; el coeficiente de determinación (R2) fue de 0,97 y el coeficiente de correlación intraclase fue 0,99 con un IC de 0,98 a 0,99.Conclusiones El glucosímetro evaluado (StatStrip) presenta una buena asociación lineal, precisión y exactitud, cuando es comparado con el método de referencia del laboratorio clínico. Es un dispositivo adecuado para la monitorización de la glucosa(AU)

Introduction Hyperglycemic patients admitted to Intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose.Material and methods Eighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline.Results Mean whole blood glucose level measured by the glucose meter was 126.53+49.28mg/dL (range, 33.5-431mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13+78.6mg/dL (range, 43-451mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98 to 0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98 to 0.99.ConclusionsThe tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring(AU)

[Validation of a glucose meter at an intensive care unit]. / Validación de un glucómetro en una unidad de cuidados intensivos.

INTRODUCTION: Hyperglycemic patients admitted to Intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose. MATERIAL AND METHODS: Eighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline. RESULTS: Mean whole blood glucose level measured by the glucose meter was 126.53+49.28 mg/dL (range, 33.5-431 mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13+78.6 mg/dL (range, 43-451 mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98 to 0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98 to 0.99. CONCLUSIONS: The tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring.

Cribado combinado del primer trimestre para trisomía 21. Nuestra experiencia en los dos primeros años / Screening combined risk first trimester for trisomy 21. Our experience in the first two years

Introducción. En los últimos años se han propuesto una serie de marcadores bioquímicos y ecográficos en el primer y segundo trimestre de gestación para el cribado prenatal de la trisomía 21 y otras aneuploidías. El objetivo de este trabajo ha sido evaluar la eficacia del cribado bioquímico-ecográfico de la trisomía 21 en el primer trimestre de la gestación. Material y métodos. Se estudiaron un total de 6.497 pacientes entre febrero de 2007 y octubre de 2009. Se determinaron los parámetros bioquímicos hCG libre y PAPP-A mediante quimioluminiscencia (IMMULITE 2000, de Siemens). La exploración ultrasónica fue realizada por ecografistas expertos, mediante ecógrafo de alta resolución (Voluson 730 Pro V de General Electric), siguiendo la metodología descrita por Nicolaides. La estimación del riesgo se realizó mediante el programa informático PRISCA 4.0.15.9. Resultados. La aplicación de cribado combinado ha dado como resultado un aumento de la sensibilidad para la trisomía 21 del 75%, con una tasa de falsos positivos del 2, 24%; la especificidad fue del 97,6%; VPP 2,0% y VPN 99,9%. Conclusiones. Se obtiene un incremento en la capacidad de detección del cribado bioquímico-ecográfico del primer trimestre para la trisomía 21, respecto al cribado bioquímico del primer y segundo trimestre. Los resultados obtenidos en nuestro estudio son similares a la mayoría de los publicados en la bibliografía. Por tanto, la aplicación del cribado combinado da como resultado una alta efectividad (AU)

Background. In the last few years, many biochemical and ultrasound markers have been investigated as a prenatal screening of trisomy 21 and other aneuploidies during first and second quarter of pregnancy. The primary aim of this investigation was to evaluate the usefulness of combined biochemical and ultrasound screening of trisomy 21 during first quarter of pregnancy. Material and methods. A total of 6,497 pregnant women were studied from February 2007 to October 2009. Maternal serum levels of free human chorionic gonadotrophin (hCG) and pregnancy associated plasma protein A (PAPP-A) were measured by a chemiluminiscence immunoassay (IMMULITE 2000, Siemens). All women underwent a high-resolution ultrasound (Voluson 730 ProV of general Electric) by an expert ecographist following Nicolaides’ method. Risks estimation was performed using PRICA 4.0.15.9 software. Results. Combined screening attained a sensitivity of 75.0% for detecting foetal trisomy 21, with a false positive rate of 2.24%, and a specificity of 97.8%, with a predictive positive value of 2.0% and a predictive negative value of 99.9%. Conclusions. Combined biochemical and ultrasound screening enhance the accuracy of detection of trisomy 21 during first quarter of pregnancy in comparison with biochemical screening during first and second quarter. Our results were consistent with most publications. In conclusion, using combined screening improves effectiveness (AU)

Empleo de un nuevo protocolo de extracción y disminución de las falsas hiperprolactinemias / Use of a new protocol for prolactin extraction and reduction of false hyperprolactinemia

Introducción La medición de prolactina está influenciada por una serie de factores y ello ha sido descrito por numerosos autores, lo que puede falsear el valor obtenido no correspondiendo el mismo a la realidad fisiológica del individuo estudiado. Si no se adoptan una serie de medidas, sobre todo en la fase preanalítica, pueden aparecer resultados más altos. Como objeto pretendemos evaluar en qué medida la optimización o no de la extracción en sí, se traduce en resultados más altos y como el informe realizado en términos de prolactina monomérica (activa biológicamente) puede ser decisivo a la hora de adoptar un diagnóstico y actitud terapéutica. Material y métodos Para ello realizamos 2 extracciones a cada mujer (previa observación del protocolo que universalmente se contempla para este tipo de análisis) una por punción directa y otra a los 60min sin nueva punción (se canaliza la vena en la punción directa y se mantiene permeable por salinización) y con posterioridad estudiamos la fracción monomérica, en los casos requeridos. Resultados De los resultados obtenidos podemos deducir una diferencia significativa desde el punto de vista estadístico entre la punción directa y a los 60min y al observar la fracción monomérica se encuentra concentraciones hasta 3 veces menores que los obtenidos por punción directa. Discusión Los resultados de nuestro estudio justifican la sistematización del uso de técnicas de extracción que soslayen el estrés de la venopuntura y el informe de prolactina con actividad biológica (monomérica, «little») (AU)

Introduction Numerous authors have reported that prolactin measurement is influenced by several factors and consequently the values obtained may not faithfully reflect the physiological reality of the individual studied. Unless a series of measures is adopted, especially in the pre-analytic stage, values may be falsely elevated. The objective of the present study was to evaluate the extent to which optimization or non-optimization of the extraction procedure translates into higher results and how reports expressed in terms of monomeric (biologically active) prolactin could be crucial to adopt a diagnosis and therapeutic approach. Material and methods We performed two extractions in each woman (following the protocol universally used for this kind of analysis): one through direct puncture and another 60min later without a new puncture (a catheter was inserted in the site of the first puncture and kept permeable by salinization). The monomeric fraction was then studied, if required. Results A statistically significant difference was observed between the 2 extractions. The monomeric fraction was three times lower in the second extraction than in the first. Discussion The results of this study justify systematic use of extraction techniques that avoid the stress of venous puncture, as well as the use of the term biologically active prolactin [monomeric (little) prolactin fraction] in reports (AU)

[Use of a new protocol for prolactin extraction and reduction of false hyperprolactinemia]. / Empleo de un nuevo protocolo de extracción y disminución de las falsas hiperprolactinemias.

INTRODUCTION: Numerous authors have reported that prolactin measurement is influenced by several factors and consequently the values obtained may not faithfully reflect the physiological reality of the individual studied. Unless a series of measures is adopted, especially in the pre-analytic stage, values may be falsely elevated. The objective of the present study was to evaluate the extent to which optimization or non-optimization of the extraction procedure translates into higher results and how reports expressed in terms of monomeric (biologically active) prolactin could be crucial to adopt a diagnosis and therapeutic approach. MATERIAL AND METHODS: We performed two extractions in each woman (following the protocol universally used for this kind of analysis): one through direct puncture and another 60 min later without a new puncture (a catheter was inserted in the site of the first puncture and kept permeable by salinization). The monomeric fraction was then studied, if required. RESULTS: A statistically significant difference was observed between the 2 extractions. The monomeric fraction was three times lower in the second extraction than in the first. DISCUSSION: The results of this study justify systematic use of extraction techniques that avoid the stress of venous puncture, as well as the use of the term biologically active prolactin [monomeric (little) prolactin fraction] in reports.